Rec­om­men­da­tions

10.19 For pa­tients of all ages with di­a­betes and atheroscle­rot­ic car­dio­vas­cu­lar dis­ease or 10- year atheroscle­rot­ic car­dio­vas­cu­lar dis­ease risk >20%, high-‍in­ten­si­ty statin ther­a­py should be added to lifestyle ther­a­py. A

10.20 For pa­tients with di­a­betes aged <40 years with ad­di­tional atheroscle­rot­ic car­dio­vas­cu­lar dis­ease risk fac­tors, the pa­tient and pro­vider should con­sid­er using mod­er­ate-‍in­ten­si­ty statin in ad­di­tion to lifestyle ther­a­py. C

10.21 For pa­tients with di­a­betes aged 40–75 years A and >75 years B with­out atheroscle­rot­ic car­dio­vas­cu­lar dis­ease, use mod­er­ate-‍in­ten­si­ty statin in ad­di­tion to lifestyle ther­a­py.

10.22 In pa­tients with di­a­betes who have mul­ti­ple atheroscle­rot­ic car­dio­vas­cu­lar dis­ease risk fac­tors, it is rea­son­able to con­sid­er high-‍in­ten­si­ty statin ther­a­py. C

10.23 For pa­tients who do not tol­er­ate the in­tend­ed in­ten­si­ty, the max­i­mal­ly tol­er­at­ed statin dose should be used. E

10.24 For pa­tients with di­a­betes and atheroscle­rot­ic car­dio­vas­cu­lar dis­ease, if LDL choles­terol is ≥70 mg/dL on max­i­mal­ly tol­er­at­ed statin dose, con­sid­er adding ad­di­tional LDL-‍low­er­ing ther­a­py (such as eze­tim­ibe or PCSK9 in­hibitor). A Eze­tim­ibe may be pre­ferred due to lower cost.

10.25 Statin ther­a­py is contrain­di­cated in preg­nancy. B